Heroin Overdose Epidemic - what is your perspective?

[okie john]

As I have posted elsewhere here, I have literally decades of experience with opiods, especially Oxycontin - not by choice. I have been extremely blessed to be able to stay controlled and functional for these many years, having been told I am very unusual because my dosages haven't changed in 4+ years. I'm not a Dr., but feel I'm eminently qualified to say the following. With all due respect, okie john, prescribing Oxycontin, a time-release med, for post-op pain is way out of line and is one of the main causes of folks getting hooked. Unfortunately, it happens all the time as Drs., even now, continue to write for Oxycontin, for situations just like your fiance - out of sheer ignorance. Oxycontin is a drug I am VERY familiar with and should ONLY be used in chronic (think never-ending here) pain control situations. The proper med for cases such as yours would be Vicodin, a short-acting med for short term pain control, or something in that same category.

I'm not a medical professional so I don't feel qualified to comment on this. There are other complicating factors that I can't really discuss online, but certainly I appreciate your input.

Oxy could be either Oxycontin, a specific form of long acting narcotic, or Oxycodone, the ingredient in multiple narcotic pain medications including oxycontin. Oxycodone can be a short acting narcotic used post surgically as well. I don't know which version Okie John's fiance was given, but it may not have been the long acting version you are used to.

We've got some long-acting stuff and some short-acting stuff. At any rate, she's cutting back on the dose and it seems to be working.


Okie John

[11B10]

To all here - thanks for correcting me. I was just ASSuming (such a dangerous word) that okie john meant Oxycontin and based my comments on that assumption.

[okie john]

No blood, no foul.


Okie John

[rojocorsa]

This is a link that Mr. Haggard shared on FB regarding SWAT officers going to the hospital after coming in contact with airborne fentanyl.

http://www.policeone.com/swat/articl...l-during-raid/

[Nephrology]

This is a link that Mr. Haggard shared on FB regarding SWAT officers going to the hospital after coming in contact with airborne fentanyl.

http://www.policeone.com/swat/articl...l-during-raid/

Yeah don't mess with fentanyl. It's incredibly potent in very small quantities. 25 micrograms is enough to achieve analgesia in someone used to ~60mg of morphine per day. For perspective, a grain of rice weighs 15 MILLIgrams; or a little less than 1000 times more than the 25 microgram dose of fentanyl.

[Lon]

Up front: I haven't read the whole thread, just the first couple pages.

So we have a huge heroin problem here in my AO. Here's what I've seen. When I worked narcotics from 07-11, we rarely saw heroin. Mostly crack, coke, weed, pills and home made meth. Now we are seeing mostly heroin and meth imported from out of the area.

I blame doctors for the problem, to a certain extent. Until 2009-10 it was ridiculously easy to get multiple prescriptions for pain meds. Lotsa people got hooked on pain pills. Doctors were passing that shit out like candy and were less then cooperative with LE when we tried to do "Dr. Shopping" investigations. Those type of investigations were much more time consuming than going out and running CI buys so the Dr. Shopping investigations got put on the back burner. Around 2009 Ohio Law changed so that all prescriptions for certain drugs (opioids, anti-depressants, etc.) had to entered in a statewide database. Drs are now required to check that system before prescribing those meds to make sure the patient isn't seeing multiple Drs. Pharmacies are required to check that database (called OARRS) before filling the script. LE was also given access to the database (there's a vetting and checks and balance process). Since then, Dr. shopping is not nearly so much of a problem. There are still a bunch of shady "pain clinics" out there selling scripts for cash, but family doctors and ERs don't see the people they used to.

But those people were still addicted and turned to heroin. In the last couple years we're seeing heroin deaths that are fentanyl related. Either the heroin is laced with fentanyl or what was sold as heroin was, in fact, straight fentanyl. About half the deaths we are seeing are people just getting out of jail or treatment who hit the same amount as they did before being locked up for weeks. Their body doesn't have the tolerance it used to and bam, they're DRT. Unless someone is close who calls 911.

We've been carrying narcan in our cars for a year and a half. Saved a bunch of junkies. FD has saved a bunch as well. Now the big thing is for the junkies to go to our local health care place and get narcan for free. Of course it's for a "family member". And then they have narcan parties with a designated narcan giver. Hell, we bust people on a regular basis coming back from Dayton who are shooting up while they are driving because they can't wait to get back home.

My biggest regret is that I didn't buy stock in the company who came up with narcan 20 years ago.

[Nephrology]

Since then, Dr. shopping is not nearly so much of a problem. There are still a bunch of shady "pain clinics" out there selling scripts for cash, but family doctors and ERs don't see the people they used to.

Anecdotally, the ER I am training in doesn't give out opioids very often, and only for moderate to severe acute pain. If we write people for opiates it's usually a short course and something mild like vicodin/percocet. Drug seekers are not as common as I thought they would be, but they do exist. The only patients we pour narcotics into are cancer patients, esp. stage IV/DNR/palliative care patients. I don't feel particularly bad about that.

This basically is in line with what we are now taught in med school. Opioids are for acute post-operative/post-traumatuc pain or cancer. Pour them on in palliative care. For other chronic pain - arthritis, whatever - NSAIDs and antidepressants in certain chronic pain conditions. I don't think anyone in my class was given the impression it would be OK to write someone for oxycodone every month without a really damn good reason.

[45dotACP]

Truth be told, I haven't run across a huge number of drug seekers as a RN and unless I feel the pain meds will negatively affect their breathing, I'll not spare any effort in getting pain under control...just ask the intensivists I wake up at 2am for new pain med orders.

I work in the critical care/stepdown type environments...one of my most recent people was a 20something IV drug addict who got bacterial endocarditis, went septic and ended up with purpura fulminans... probably won't survive and will be in agonizing pain for the duration. It's a really fucking bad way to check out....not quite the blissful high you never wake up from this patient so obviously expected.

Don't do drugs kids. Drugs can fuck you up ugly.

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[whomever]

Relevant article from a local station:

http://www.kxly.com/home-and-family/...1699520?item=0

Town of 49000 ... estimated 12000 opioid addicts. I don't even know what to think about that.

[KeeFus]

One of our latest OD death was from a mixture of fentanyl and heroin...but product was mostly fentanyl...not heroin. Whoever mixed that shit must've lost track. I just read that fentanyl is upwards of 80 times more potent that morphine.